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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005994
Report Date: 06/30/2022
Date Signed: 06/30/2022 11:15:18 AM


Document Has Been Signed on 06/30/2022 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:WILLOW TREE SCHOOL - PRESCHOOLFACILITY NUMBER:
493005994
ADMINISTRATOR:STILL, CHERYL M.FACILITY TYPE:
850
ADDRESS:137 PAYRAN STREETTELEPHONE:
(707) 763-2546
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:27CENSUS: 12DATE:
06/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cheri StillTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee to evaluate the number of toddlers that will be allowed in the toddler options. The licensee will increase the number of toddlers under the preschool license. The facility can utilize two adjacent rooms to run the toddler program which is physically separated from the preschool age children. There is a separate outdoor area for the children in the toddler program.

The facility is approved for up to 11 toddlers, the remainder of the children will be of preschool age. LPA Ouye explained to the licensee that if the facility has fewer than 11 toddlers, the facility may increase the number of preschool children as long as the maximum number of toddlers does not exceed 11 toddlers and the total capacity does not exceed 27 children between the preschool and toddler programs.

LPA Ouye will send a new licensed to the licensee to reflect the increased number of toddlers.

No deficiencies during the visit,
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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